TY - JOUR
T1 - High-Grade Cervical Dysplasia after Negative Loop Electrosurgical Excision Procedure
AU - Kuroki, Lindsay M.
AU - James-Nywening, Laura
AU - Wu, Ningying
AU - Liu, Jingxia
AU - Powell, Matthew A.
AU - Thaker, Premal H.
AU - Massad, L. Stewart
N1 - Publisher Copyright:
© 2016, American Society for Colposcopy and Cervical Pathology.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Objectives To describe the prevalence and correlates of high-grade cervical intraepithelial neoplasia (CIN2+) after a negative loop electrosurgical excision procedure (LEEP), performed for high-grade squamous intraepithelial lesion (HSIL) cervical cytology. Methods One hundred six women from our university-based colposcopy clinic underwent LEEP between 2007 and 2014. Negative LEEP was defined as CIN1 or less. Persistence/recurrence estimates were calculated by treatment (see-and-treat vs 3-step conventional strategy - cervical cytology, colposcopic biopsy, LEEP) and LEEP results (negative vs positive) using the Kaplan-Meier method. Predictors of CIN2+ after a negative LEEP were examined by multivariate Cox proportional hazards model. Results Overall, the prevalence of CIN2+ after a negative LEEP for HSIL was 14%. Persistence/recurrence of CIN2+ was similar between women with a negative and positive see-and-treat LEEP (25% vs 15%) and those with a negative or positive 3-step conventional LEEP (7% vs 22%) (log-rank, P = 0.58). Positive LEEP margin was more common among women with a positive LEEP (53.7% see-and-treat vs 42.6% conventional) compared with a negative result (0% see-and-treat vs 3.7% conventional, P < 0.0001). The risk of CIN2+ after a negative LEEP did not differ by management strategy (log-rank, P = 0.85) or LEEP result (log-rank, P = 0.58). In multivariate analysis, correlates of persistent/recurrent CIN2+ included older age (adjusted odds ratio [aOR], 1.09; P = 0.0003), history of previous LEEP (aOR, 8.99; P < 0.0001), and positive LEEP margin (aOR, 13.56; P = 0.0005). Conclusions A negative LEEP does not allow less stringent surveillance, as CIN2+ risk is similar to that after CIN2+ is found in the LEEP specimen, whether the specimen was obtained by see-and-treat or conventional 3-step approach.
AB - Objectives To describe the prevalence and correlates of high-grade cervical intraepithelial neoplasia (CIN2+) after a negative loop electrosurgical excision procedure (LEEP), performed for high-grade squamous intraepithelial lesion (HSIL) cervical cytology. Methods One hundred six women from our university-based colposcopy clinic underwent LEEP between 2007 and 2014. Negative LEEP was defined as CIN1 or less. Persistence/recurrence estimates were calculated by treatment (see-and-treat vs 3-step conventional strategy - cervical cytology, colposcopic biopsy, LEEP) and LEEP results (negative vs positive) using the Kaplan-Meier method. Predictors of CIN2+ after a negative LEEP were examined by multivariate Cox proportional hazards model. Results Overall, the prevalence of CIN2+ after a negative LEEP for HSIL was 14%. Persistence/recurrence of CIN2+ was similar between women with a negative and positive see-and-treat LEEP (25% vs 15%) and those with a negative or positive 3-step conventional LEEP (7% vs 22%) (log-rank, P = 0.58). Positive LEEP margin was more common among women with a positive LEEP (53.7% see-and-treat vs 42.6% conventional) compared with a negative result (0% see-and-treat vs 3.7% conventional, P < 0.0001). The risk of CIN2+ after a negative LEEP did not differ by management strategy (log-rank, P = 0.85) or LEEP result (log-rank, P = 0.58). In multivariate analysis, correlates of persistent/recurrent CIN2+ included older age (adjusted odds ratio [aOR], 1.09; P = 0.0003), history of previous LEEP (aOR, 8.99; P < 0.0001), and positive LEEP margin (aOR, 13.56; P = 0.0005). Conclusions A negative LEEP does not allow less stringent surveillance, as CIN2+ risk is similar to that after CIN2+ is found in the LEEP specimen, whether the specimen was obtained by see-and-treat or conventional 3-step approach.
KW - HSIL cytology
KW - negative see-and-treat LEEP
KW - recurrent CIN2+
UR - http://www.scopus.com/inward/record.url?scp=84984698486&partnerID=8YFLogxK
U2 - 10.1097/LGT.0000000000000260
DO - 10.1097/LGT.0000000000000260
M3 - Article
C2 - 27575575
AN - SCOPUS:84984698486
SN - 1089-2591
VL - 20
SP - 300
EP - 306
JO - Journal of lower genital tract disease
JF - Journal of lower genital tract disease
IS - 4
ER -